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Progress on SIAs and MCV2 introduction in India

Progress on SIAs and MCV2 introduction in India. Dr. Pradeep Haldar Deputy Commissioner (Immunization) Ministry of Health & Family Welfare Government of India. Washington DC 18-19 Sep 12. Measles Vaccination in India.

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Progress on SIAs and MCV2 introduction in India

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  1. Progress on SIAs and MCV2 introduction in India Dr. Pradeep Haldar Deputy Commissioner (Immunization) Ministry of Health & Family Welfare Government of India Washington DC 18-19 Sep 12

  2. Measles Vaccination in India • Measles vaccination was introduced under the National Universal Immunization Programme (UIP) in 1985 given to children at 9-12 months age • Line listing of measles outbreak cases started in 2005 in selected states. • In 2010, Government of India introduce 2nd dose of Measles under UIP through a two prong strategy.

  3. 2nd dose of Measles vaccine: State specific delivery strategies • National Technical Advisory Group on Immunization recommended second dose of measles vaccine for all states through state specific delivery strategies. • 14 states with MCV1 <80%: Measles SIA (9 month to <10 years) followed 6 month later by MCV2 under RI • 21 states with MCV1 > 80%: MCV2 under RI at 16 to 24 months of age MCV2: Coverage of Measles containing vaccine 2nd dose per DLHS-3; CES-06 for Nagaland

  4. MCUP: Basic considerations • All children in target age-group (9 mo-<10 years) to be vaccinated • Irrespective of previous doses of measles vaccine received • Irrespective of prior history of measles disease • In general, this age group constitutes around 18-25% of the total population • Target: ~135 million children • Expected coverage: More than 90% (evaluated coverage) • Massive public health undertaking with an injectable vaccine • Both safety and high coverage are critical • MOH&FW decided to take a phased approach

  5. MCUP: Basic operational strategy All immunizations from static posts (no HTH immunization) Regular routine immunization sessions will be conducted without interruption Two regular routine immunization clinics per week Measles catch-up campaign in remaining four days Average Campaign duration: 3 weeks = 12 working days 1st week: School based campaign (for 5-10 year children) 2nd & 3rd weeks: Community based campaign for non-school going children or children missed during school week Training Only trained persons (ANMs) will work as vaccinators All ASHA/ AWW will be trained for beneficiary listing and Inter-personal communication Doctors (including clinicians in pvt. sector) have been trained in managing rare adverse events, if any

  6. MCUP: session sites and teams Types of session sites Session sites at Educational Institutes. Outreach site (regular RI sites and additional sites in village/urban mohalla) Mobile/Special team Facility based session site Team composition 1-2 Auxiliary Nurse Midwife (ANMs) ASHA (Accredited Social Health Activist) AWW (Anganwadi Worker) Volunteer

  7. Overview of Measles SIA • Target population: • ~ 135 million children 9 months – 10 years of age • 365 districts in 14 states Phase 1, 45 districts covered (~ 13 million) Phase 2, 152 districts covered (~ 40 million Phase 3, 167 districts planned (~ 81 million) Phase 1 in 2010 -11; Phase 2 in 2011-12; Phase 3 in 2012-13 Starting Sep 12

  8. Measles catch-up campaign (MCUP)

  9. Measles SIA phasing plan, India

  10. Coverage achieved: Administrative and RCA monitoring (MCUP Phase 1 & 2) 48,179,400 of 54,013,266 vaccinated (89.2%) 98 of 197 districts with >= 90% coverage Number of Childrenmonitored

  11. Campaign awareness & source of information (in %) • Vast majority of those monitored were aware of the campaign • Session sites with visible IEC material – 82.6% • Sites where social mobilization was being done by house visits – 88.3% N= 638,660 children monitored

  12. Reasons for missing vaccination during Measles catch-up campaigns-India (RCA) • Social mobilisation includes • Parents didn’t know of campaigns, • Didn’t know about Place/Date, • Didn't give Importance • Fear of Injection & AEFI • Operational • No vaccine/logistics • No vaccinator • Site too far, long queue • Others • Family travelling, sick child, • Gone to School etc (N – 87,197) N - Total No of Unvaccinated children verified by RCA – (87,197)

  13. All State Governments have issued orders to include Measles 2nd dose under RI in campaign districts after 6 months

  14. Measles SIA timeline (3rd phase)

  15. Partner support in measles 2nd dose • Key partners : WHO and UNICEF • Areas of Support: • Support to steering committee and operational groups at national, state and district level. • Development of strategic guidelines, tools and IEC prototypes • Program implementation support to states incl. capacity building and supportive supervision • Media sensitization at national, state and district levels • Surveillance in 11 states • Strengthening cold chain through assessment, supply and capacity building • Micro-planning, training, and social mobilization using polio resources (SMOs and SMNet) • Campaign monitoring • Data analysis and dissemination incl. quarterly newsletter

  16. Summary of measles 2nd dose Measles 2nd dose under RI at 16-24 months introduced in 21 States/UTs in 2010 Measles SIA completed in 197 districts in 14 states with coverage of 90% in two phases. In 9 states out of 14 completed measles SIA in all districts. 2nd dose of measles under RI started 6 month after measles SIA Remaining 167 districts in 5 states planned/ on going measles SIA during 2012-13 with target of 81 million children (UP, MP, BI, RAJ, GUJ) Case based surveillance, expansion of laboratory network, Rubella vaccination refer to sub committee of NTAGI on strategy ie vaccinate children or adolescent group or both. MEASLES 2ND DOSE WILL BE UNIVERASLIZED IN THE ENTIRE COUNTRY BY 2014

  17. Impact on measles transmission [Data as on August 2012]

  18. SIA and RI PlansLine listing of measles surveillance States with MCV2 through MCUP States with MCV2 in RI Surveillance initiated 2006 2007 2009 2010 2011 2012* MCUP: Measles catch-up campaign MCV2: Measles containing vaccine, 2nd dose * State workshops conducted in Haryana, March 2012

  19. Measles cases and outbreaks in districts completed catch-up campaigns and lab supported measles surveillance before and after start of MCUP Data as on 13/08/2012

  20. Summary Of 14 states implementing measles SIA, 6 states (Assam, Bihar, Gujarat, Jharkhand, MP & Rajasthan) have lab supported measles surveillance data to make before-after comparisons The ‘post-’ window for phase-2 activity is <1 year (Range: 1-7 months) for all states Surveillance sensitivity is variable across states and should be taken into account while interpreting results Quality of MCUP activities have also varied among states Overall, in phase 1 & 2 districts Overall the MCUP strategy has been effective in reducing measles transmission In measles 2nd dose states the size and frequency of measles outbreak reduced

  21. Thank-You

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